Mechanisms of Mindfulness and Stress Resilience: A Mobile App Mindfulness Training Study

Mind and Life Institute, Hadley, Massachusetts, Yoga Science Foundation, Penn State University, University of Pittsburgh, Virginia Commonwealth University, 01 Expert Systems, LLC

The purpose of this study is to test the active components of mindfulness meditation for reducing psychological stress and improving biomarkers of health. This study compares the effects of three brief trainings: (1) training in both present-moment attention and mindful acceptance, (2) training in present-focused attention, and (3) an active psychological training with no mindfulness content.

Mindfulness meditation practices are widely used among the general public, with people seeking to reduce stress, pain, inflammation, depression, and disease symptoms. Moreover, randomized controlled trials have shown mindfulness training programs to be effective in improving a broad range of psychological and physical health outcomes, particularly among populations with high stress burdens. Still, little is known about the mechanisms underlying mindfulness training that drive these effects. This study tests the active components of mindfulness that impact stress responding and health biomarkers. The study separates attention and acceptance mindfulness instructions into three 14-day training programs delivered to a stressed adult population: (1) attention and acceptance instructions, (2) attentional monitoring instructions only, or (3) analytic thinking with no mindfulness instruction. Intervention programs are delivered on participants' own smartphones, providing a platform for maximal experimental control in testing the active ingredients of mindfulness training. Participants are recruited from the Pittsburgh community. At a baseline laboratory session, they complete psychosocial questionnaires and tasks and provide a dried blood spot sample. On their own, they complete pre- and post-intervention Ecological Momentary Assessment measures of stress, attention, and acceptance in daily life. Between these assessments, participants have 14 days to complete their randomly assigned 14-lesson intervention program. Participants return to the lab for post-intervention assessments (questionnaires, tasks, dried blood sample), listen to a final training session from their intervention program, and complete the Trier Social Stress Test. Participants are compensated.

14-lesson audio-guided mindfulness training program instructing present-moment attention and an orientation of acceptance

14-lesson audio-guided analytic thinking program encouraging reflection on one's thoughts, feelings, and behaviors, but not instructing mindfulness

Mindfulness training intervention consisting of 14 x 20-minute audio-guided lessons that participants access on their smartphones during the 14-day intervention period.

Mindful attention training intervention consisting of 14 x 20-minute audio-guided lessons that participants access on their smartphones during the 14-day intervention period.

Comparison analytic thinking intervention consisting of 14 x 20-minute audio-guided lessons that participants access on their smartphones during the 14-day intervention period.

change from baseline 3-day period to post-intervention 3-day period, which is an average of 2.5 weeks

Five Dried Blood Spot samples are obtained from participants' finger for assessment of circulating markers of inflammation (CRP, IL-6).

change from baseline 3-day period to post-intervention 3-day period, which is an average of 2.5 weeks

assessed at post-intervention, which is an average of 3.5 weeks, at time 0, and 25, 35, and 60 minutes post-TSST

assessed at post-intervention, which is an average of 3.5 weeks, at 2-minute intervals during session

change from baseline 3-day period to post-intervention 3-day period, which is an average of 2.5 weeks

change from baseline 3-day period to post-intervention 3-day period, which is an average of 2.5 weeks

change from baseline 3-day period to post-intervention 3-day period, which is an average of 2.5 weeks

composite of ratings made after each of 14 intervention lessons, an average of 2 weeks following baseline

Inclusion Criteria: English speaking Moderate- to high-stress (4-item Perceived Stress Scale score of 6 or higher) Exclusion Criteria: Diagnosis of chronic mental (e.g., recurrent depression, schizophrenia, personality disorder) or physical disease (e.g., cancer, HIV, heart disease, diabetes, bleeding disorder) Hospitalization in past 3 months Medication use that interferes with HPA-axis activity (e.g., corticosteroids) Current oral contraceptive use Current antibiotic, antiviral, or antimicrobial treatment Travel outside the country within the past 6 months to any country on the CDC travel alert list Recreational drug use, excessive alcohol or tobacco use Significant experience with or daily practice of mindfulness meditation or related mind-body practice

Lindsay EK, Chin B, Greco CM, Young S, Brown KW, Wright AGC, Smyth JM, Burkett D, Creswell JD. How mindfulness training promotes positive emotions: Dismantling acceptance skills training in two randomized controlled trials. J Pers Soc Psychol. 2018 Dec;115(6):944-973. doi: 10.1037/pspa0000134.